{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T18:47:39Z","timestamp":1782067659318,"version":"3.54.5"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Evidence supporting the Micra AV leadless pacing system has largely derived from highly experienced centers, potentially limiting generalizability to routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The AV-CESAR study (French Cohort Evaluating the Effectiveness of Atrioventricular Synchrony by the micRa AV) is a nationwide retrospective cohort, including the first 1000 patients implanted with a Medtronic Micra AV leadless pacemaker in France (2020\u20132024). Mean follow-up was 13.4\u00b110.6 months. Primary end points were early (in-hospital) and late (postdischarge) device-related major complications; pacemaker syndrome and need for implantation of a new pacing system were centrally adjudicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1003 patients, device implantation was successful in 1000 (99.7%). Mean age was 72.0\u00b115 years; 62.8% were men, 44.0% had \u22652 comorbidities, and 62.4% were unsuitable for transvenous pacemakers. The primary indication was permanent complete atrioventricular block with preserved sinus rhythm (78.0%). Early major complications occurred in 2.4%, including pericardial effusion (0.8%; 3 requiring surgery), access-site complications (0.8%), and thromboembolism (0.3%). Late major complications included pacemaker syndrome (2.5%), pacing-induced cardiomyopathy (1.2%), high thresholds (&gt;4 V\/0.24ms, 0.3%), and premature battery depletion (0.2%). No device infections or dislodgements were observed. Overall, 2.5% of patients required implantation of a new pacing system (pacing-induced cardiomyopathy n=11; pacemaker syndrome n=7; high threshold n=3; battery\/software failure n=3; tricuspid regurgitation n=1) and 12.7% were permanently reprogrammed to ventricular paced\/sensed, inhibited (VVI) mode. In pacing-dependent patients with ambulatory Holter monitoring (&gt;3.4 million paced cycles), mean atrioventricular synchrony was 67.6\u00b117.3% and correlated with device-reported AM-VP (74.8\u00b117.1%;\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.92;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Atrioventricular synchrony declined at heart rates &gt;90 beats per minute (5.6% of monitored time). All-cause mortality was 13.8%, with 0.2% directly device-related; 41.7% of deaths were cardiovascular.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The Micra AV system is primarily used as an alternative when dual-chamber conventional pacemakers are not feasible. It demonstrated acceptable safety and clinical performance in a high-risk population. The marked reduction in atrioventricular synchrony at higher heart rates may suggest limited clinical benefit in patients with higher exertional heart rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT05953558\">https:\/\/clinicaltrials.gov\/study\/NCT05953558<\/jats:ext-link>\n                      ; Unique identifier: NCT05953558.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.126.014850","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:02:15Z","timestamp":1779267735000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["One-Year Outcomes of the First 1000 Patients Implanted With the Medtronic Micra AV Leadless Pacing System in France: The AV-CESAR Cohort Study"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"nct05953558","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-3576","authenticated-orcid":true,"given":"Fawzi","family":"Kerkouri","sequence":"first","affiliation":[{"name":"Division of Cardiology, European Georges Pompidou Hospital, France (F.K., W.A., C.J., V.W., E.M.)."},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris Cardiovascular Research Center, France (F.K., W.A., K.N., V.W., E.M.)."},{"name":"Department of Cardiology, University Hospital of Brest, France (F.K., V.M., J.M.)."},{"name":"University of Western Brittany, ORPHY Laboratory, Brest, France (F.K., J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Clementy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinique du Mill\u00e9naire, Montpellier, France (N.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-4278","authenticated-orcid":true,"given":"Pascal","family":"Defaye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Grenoble, France (P.D., P.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5345-4851","authenticated-orcid":true,"given":"Mina","family":"Ait Said","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Private hospital Jacques Cartier, Massy, France (M.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6848-5452","authenticated-orcid":true,"given":"Antoine","family":"Andorin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Nantes, France (A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2130-9790","authenticated-orcid":true,"given":"Fr\u00e9d\u00e9ric","family":"Anselme","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Rouen, France (F.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warda","family":"Aoudjeghout","sequence":"additional","affiliation":[{"name":"Division of Cardiology, European Georges Pompidou Hospital, France (F.K., W.A., C.J., V.W., E.M.)."},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris Cardiovascular Research Center, France (F.K., W.A., K.N., V.W., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Badoz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Besancon, France (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Behar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Rennes, Rennes, France (N. 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